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An author and physician helps residents become better doctors through writing

Yale Medicine Magazine, 2004 - Summer


Physicians who listen to their patients’ stories—who listen as writers would—strengthen their relationships with those patients, according to physician and author Abraham Verghese, M.D., M.F.A. And doctors who forge these connections to their patients are likely to take better emotional care of themselves as well, said Verghese, speaking recently at medical grand rounds.

“To be aware of stories is to be empathetic. … What we’re talking about is imagining the patient’s life,” said Verghese, director of the Center for Medical Humanities and Ethics at the University of Texas Health Science Center at San Antonio. Verghese wrote My Own Country: A Doctor’s Story, a memoir of caring for AIDS patients in Tennessee in the early days of the epidemic, which Time magazine called one of the five best books of 1994.

Verghese’s talk, “What the Pen Teaches the Stethoscope,” was linked to a writer’s workshop for residents that he’d run last fall. The workshop was part of efforts by the Department of Internal Medicine to strengthen the doctor-patient relationship, said Asghar Rastegar, M.D., the department’s associate chair for medical education and academic affairs.

“Our goal is to provide a counterweight to the increasing use of medical technology, which requires less direct contact between physician and patient,” said Rastegar, who developed the writing program in partnership with former Chair Ralph I. Horwitz, M.D. (Surgeon and medical writer Atul Gawande, M.D., M.P.H., this year’s Commencement speaker, spent time with the residents in May.)

Fourteen medical residents, chosen on the basis of writing samples, spent two and a half days with Verghese critiquing one another’s work. In teaching the residents, Verghese used techniques he’d learned at the Iowa Writers’ Workshop at the University of Iowa in 1990-91. The residents compiled their stories about patients, both fictional and real, in a booklet called Capsules. They read from their work when Verghese returned in January as part of the program financed by a fund in memory of Fredrick L. Sachs, M.D.

Workshop participant Amy M. Nuernberg, M.D. ’00, chief resident in medicine, said she experienced a catharsis while writing about a college student in her care who had died in a matter of weeks. “It made me realize how strongly it had affected me,” said Nuernberg. “She wasn’t just another patient. … It helped me sort out on paper all these conflicted emotions.”

In his talk, Verghese described what he’d recommended to the residents: that they try to delineate in their patients’ predicaments elements of drama—danger, desire and a crucial insight, or epiphany. For patients, a simple doctor’s visit can contain all these elements, said Verghese: “When they come to see you, your patient is engaged in a story. … There is danger lurking. There is danger and a great desire to walk away with a clean bill of health and a blessing to go on.” Good news or bad, the diagnosis can be a kind of epiphany.

Verghese acknowledged that it’s easy to reduce patients to labels: a ROMI becomes a MIRO who may nonetheless need a CABG (that is to say: a “rule out myocardial infarction” becomes a “myocardial infarction ruled out,” possibly needing a “coronary artery bypass graft”). When doctors use “the voice of medicine,” said Verghese, “they begin to lose sight of the person, and people become almost disease labels. … Even though it’s the language of medicine you record in the chart, let the voice of the patient stay alive in your imagination.”

By writing, and thus bringing to the surface the feelings that patients’ stories engender, physicians stay in touch with their own humanity. “It’s very difficult to walk through a life in medicine and see the carnage you and I see and not to experience intense emotions,” said Verghese. But the “macho culture” of medicine encourages doctors to suppress their pain. “We’re in a very secret and lonely business.”

Gastroenterologist Michael C. Bennick, M.D., concurred with Verghese, saying that writing about a painful experience provides “an opportunity to listen all over again. You needn’t shut out that pain; once the blinding light passes, it’s often illuminating,” said Bennick, an assistant clinical professor and the associate chief of medicine, who attended the residents’ reading.

Verghese argued that doctors who repress their feelings not only distance themselves from their patients but also “begin to do that to themselves.” Verghese noted that doctors often guard against pain in dysfunctional ways. “I think of it [medicine] as a romantic pursuit, but I have seen its seamy underbelly,” said Verghese, whose 1998 memoir, The Tennis Partner: A Doctor’s Story of Friendship and Loss, tells the story of a medical resident, a close friend, struggling with a powerful addiction to drugs.

Verghese said that reading fiction could help doctors reconnect with deep feelings. As can writing.

“I would encourage everybody to keep a journal. It keeps you healthy,” said Verghese.

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